Provider Demographics
NPI:1487682936
Name:NGUYEN, VIVIAN PHUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22788 E POCO CALLE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1449
Mailing Address - Country:US
Mailing Address - Phone:773-220-3979
Mailing Address - Fax:
Practice Address - Street 1:22788 E POCO CALLE
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-1449
Practice Address - Country:US
Practice Address - Phone:773-220-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025837122300000X
AZD010263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist